There are 195 Medicare Advantage plans meeting your criteria.
2020 / 2021 Medicare Advantage Plan Information
Click here to jump to the Chart Legend |
Plan Name |
Monthly Premium |
Part A&B Maximum Out-Of Pocket |
Part D Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Formulary Drugs |
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0543 -210 -0 | | | | | |
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2021 AARP Medicare Advantage Freedom Plus (HMO-POS)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
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-- This plan not offered in 2020 --
|
H0543 -210 -0 | | | | | |
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2021 AARP Medicare Advantage Freedom Plus (HMO-POS)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
2020 AARP Medicare Advantage SecureHorizons Essential (HMO)
| $0.00 |
$4,900 |
No Rx Coverage |
H0543 -121 -0 | This plan does NOT include Prescription Drug coverage. | |
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2021 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0543 -121 -0 | | | | | |
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2021 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 AARP Medicare Advantage SecureHorizons Focus (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H0543 -168 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
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2021 AARP Medicare Advantage SecureHorizons Focus (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0543 -168 -0 | | | | | |
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2021 AARP Medicare Advantage SecureHorizons Focus (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 AARP Medicare Advantage SecureHorizons Plan 1 (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0543 -001 -0 | $4.00 | $15.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
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2021 AARP Medicare Advantage SecureHorizons Plan 1 (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0543 -001 -0 | | | | | |
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|
|
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2021 AARP Medicare Advantage SecureHorizons Plan 1 (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
2020 AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
| $0.00 |
$1,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0543 -151 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
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2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0543 -151 -0 | | | | | |
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|
|
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2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H4982 -013 -0 | | | | | |
new |
new |
new |
|
2021 Aetna Medicare Eagle Plan (HMO)
| $0.00 |
$4,200 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2020 --
|
H4982 -013 -0 | | | | | |
new |
new |
new |
|
2021 Aetna Medicare Eagle Plan (HMO)
| $0.00 |
$4,200 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H4982 -001 -0 | $0.00 | $0.00 | $42.00 | $42.00 | 3,880
2020 Formulary |
new |
new |
new |
|
2021 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,679 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H4982 -001 -0 | | | | | |
new |
new |
new |
|
2021 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,679 2021 Formulary |
|
2020 Aetna Medicare Prime Plan (HMO)
| $0.00 |
$2,200 |
$0 | Yes, some additional gap coverage. |
H0523 -061 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
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2021 Aetna Medicare Prime Plan (HMO)
| $0.00 |
$2,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0523 -061 -0 | | | | | |
|
|
|
|
2021 Aetna Medicare Prime Plan (HMO)
| $0.00 |
$2,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
2020 Aetna Medicare Select Plan (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. |
H0523 -002 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
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2021 Aetna Medicare Select Plan (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0523 -002 -0 | | | | | |
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|
|
|
2021 Aetna Medicare Select Plan (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H6229 -005 -0 | 0% | 0% | 0% | 0% | 3,024
2020 Formulary |
-- |
-- |
-- |
|
2021 Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 3,085 2021 Formulary |
|
2020 Anthem MediBlue Care On Site (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -005 -0 | $0.00 | $9.50 | $37.50 | $37.50 | 2,988
2020 Formulary |
|
|
|
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2021 Anthem MediBlue Care On Site (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.50 | $37.50 | $37.50 | 3,057 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0544 -005 -0 | | | | | |
|
|
|
|
2021 Anthem MediBlue Care On Site (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.50 | $37.50 | $37.50 | 3,057 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Anthem MediBlue Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -004 -0 | $0.00 | $7.50 | $37.50 | $37.50 | 2,988
2020 Formulary |
|
|
|
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2021 Anthem MediBlue Diabetes Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | 3,057 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0544 -004 -0 | | | | | |
|
|
|
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2021 Anthem MediBlue Diabetes Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | 3,057 2021 Formulary |
|
2020 Anthem MediBlue ESRD (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -015 -0 | $0.00 | $7.50 | $37.50 | $37.50 | 2,988
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue ESRD Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | 3,057 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0544 -015 -0 | | | | | |
|
|
|
|
2021 Anthem MediBlue ESRD Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | 3,057 2021 Formulary |
|
2020 Anthem MediBlue Heart (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -013 -0 | $0.00 | $7.50 | $37.50 | $37.50 | 2,988
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Heart Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | 3,057 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0544 -013 -0 | | | | | |
|
|
|
|
2021 Anthem MediBlue Heart Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | 3,057 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Anthem MediBlue Breathe (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -014 -0 | $0.00 | $7.50 | $37.50 | $37.50 | 2,988
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | 3,057 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0544 -014 -0 | | | | | |
|
|
|
|
2021 Anthem MediBlue Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | 3,057 2021 Formulary |
|
2020 Anthem MediBlue Plus (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H0544 -061 -0 | $7.00 | $15.00 | $42.00 | $42.00 | 3,780
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Plus (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $42.00 | $42.00 | 3,621 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0544 -061 -0 | | | | | |
|
|
|
|
2021 Anthem MediBlue Plus (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $42.00 | $42.00 | 3,621 2021 Formulary |
|
2020 Anthem MediBlue Select (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. |
H0544 -058 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,768
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Select (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,621 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0544 -058 -0 | | | | | |
|
|
|
|
2021 Anthem MediBlue Select (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,621 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Anthem MediBlue StartSmart Plus (HMO)
| $0.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0544 -007 -0 | $5.00 | $14.50 | $45.00 | $45.00 | 2,988
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue StartSmart Plus (HMO)
| $0.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $14.50 | $45.00 | $45.00 | 3,057 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0544 -007 -0 | | | | | |
|
|
|
|
2021 Anthem MediBlue StartSmart Plus (HMO)
| $0.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $14.50 | $45.00 | $45.00 | 3,057 2021 Formulary |
|
2020 Anthem MediBlue Value Plus (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. |
H0544 -002 -0 | $0.00 | $9.50 | $37.50 | $37.50 | 2,988
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Value Plus (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.50 | $37.50 | $37.50 | 3,057 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0544 -002 -0 | | | | | |
|
|
|
|
2021 Anthem MediBlue Value Plus (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.50 | $37.50 | $37.50 | 3,057 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H3815 -027 -0 | | | | | |
|
|
|
|
2021 AVA (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,417 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H3815 -027 -0 | | | | | |
|
|
|
|
2021 AVA (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,417 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Blue Shield 65 Plus (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H0504 -015 -0 | $0.00 | $5.00 | $38.00 | $38.00 | 3,663
2020 Formulary |
|
|
|
|
2021 Blue Shield 65 Plus (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $38.00 | $38.00 | 3,638 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0504 -015 -0 | | | | | |
|
|
|
|
2021 Blue Shield 65 Plus (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $38.00 | $38.00 | 3,638 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0504 -021 -0 | | | | | |
|
|
|
|
2021 Blue Shield 65 Plus Plan 2 (HMO)
| $0.00 |
$1,899 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,638 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Blue Shield 65 Plus Choice Plan (HMO)
| $0.00 |
$1,899 |
$0 | Yes, some additional gap coverage. |
H0504 -021 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,663
2020 Formulary |
|
|
|
|
2021 Blue Shield 65 Plus Plan 2 (HMO)
| $0.00 |
$1,899 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,638 2021 Formulary |
|
2020 Blue Shield Promise AdvantageOptimum Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H5928 -004 -0 | $0.00 | $3.00 | $40.00 | $40.00 | 3,112
2020 Formulary |
|
|
|
|
2021 Blue Shield AdvantageOptimum Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,202 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5928 -004 -0 | | | | | |
|
|
|
|
2021 Blue Shield AdvantageOptimum Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,202 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Blue Shield Inspire (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H0504 -043 -0 | $0.00 | $3.00 | $35.00 | $35.00 | 3,363
2020 Formulary |
|
|
|
|
2021 Blue Shield Inspire (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $35.00 | $35.00 | 3,413 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0504 -043 -0 | | | | | |
|
|
|
|
2021 Blue Shield Inspire (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $35.00 | $35.00 | 3,413 2021 Formulary |
|
2020 Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0148 -002 -0 | 0% | 0% | 0% | 0% | 3,110
2020 Formulary |
-- |
-- |
-- |
|
2021 Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 3,202 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Blue Shield Vital (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0504 -044 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,054
2020 Formulary |
|
|
|
|
2021 Blue Shield Vital (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,065 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0504 -044 -0 | | | | | |
|
|
|
|
2021 Blue Shield Vital (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,065 2021 Formulary |
|
2020 Brand New Day Bridges Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0838 -028 -0 | $0.00 | $9.00 | $45.00 | $45.00 | n/a |
|
|
|
|
2021 Brand New Day Bridges Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,207 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0838 -028 -0 | | | | | |
|
|
|
|
2021 Brand New Day Bridges Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,207 2021 Formulary |
|
2020 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H0838 -025 -0 | $0.00 | $9.00 | $47.00 | $47.00 | n/a |
|
|
|
|
2021 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,207 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0838 -025 -0 | | | | | |
|
|
|
|
2021 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,207 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Brand New Day Classic Care II Plan (HMO)
| $0.00 |
$999 |
$125 | Yes, some additional gap coverage. |
H0838 -037 -0 | $0.00 | $12.00 | $47.00 | $47.00 | n/a |
|
|
|
|
2021 Brand New Day Classic Care II Plan (HMO)
| $0.00 |
$999 |
$50 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,207 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0838 -037 -0 | | | | | |
|
|
|
|
2021 Brand New Day Classic Care II Plan (HMO)
| $0.00 |
$999 |
$50 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,207 2021 Formulary |
|
2020 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0838 -039 -1 | $0.00 | $12.00 | $47.00 | $47.00 | n/a |
|
|
|
|
2021 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | 3,207 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0838 -039 -1 | | | | | |
|
|
|
|
2021 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | 3,207 2021 Formulary |
|
2020 Brand New Day Harmony Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$100 | Yes, some additional gap coverage. |
H0838 -032 -0 | $0.00 | $10.00 | $45.00 | $45.00 | n/a |
|
|
|
|
2021 Brand New Day Harmony Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$100 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 3,207 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0838 -032 -0 | | | | | |
|
|
|
|
2021 Brand New Day Harmony Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$100 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 3,207 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0838 -042 -0 | | | | | |
|
|
|
|
2021 Brand New Day Select Care I Plan (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | 3,207 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0838 -042 -0 | | | | | |
|
|
|
|
2021 Brand New Day Select Care I Plan (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | 3,207 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H7594 -001 -0 | | | | | |
new |
new |
new |
|
2021 Brandman Health Plan (Arise) (HMO C-SNP)
| $0.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $47.00 | $47.00 | tbd |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H7594 -003 -0 | | | | | |
new |
new |
new |
|
2021 Brandman Health Plan (Aspire) (HMO C-SNP)
| $0.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $45.00 | $45.00 | tbd |
|
2020 Central Health Focus Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5649 -006 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,562
2020 Formulary |
|
-- |
|
|
2021 Central Health Focus Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,560 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5649 -006 -0 | | | | | |
|
-- |
|
|
2021 Central Health Focus Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,560 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Central Health Medicare Plan (HMO)
| $0.00 |
$2,995 |
$0 | Yes, some additional gap coverage. |
H5649 -001 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,562
2020 Formulary |
|
-- |
|
|
2021 Central Health Medicare Plan (HMO)
| $0.00 |
$1,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,560 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5649 -001 -0 | | | | | |
|
-- |
|
|
2021 Central Health Medicare Plan (HMO)
| $0.00 |
$1,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,560 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H7607 -002 -1 | | | | | |
new |
new |
new |
|
2021 Clever Care Longevity Medicare Advantage (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. | 0% | $5.00 | $35.00 | $35.00 | 3,560 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Connected Care (HMO)
| $0.00 |
$1,499 |
$0 | Yes, some additional gap coverage. |
H2241 -012 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,764
2020 Formulary |
|
|
|
|
2021 Connected Care (HMO)
| $0.00 |
$1,499 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 3,560 2021 Formulary |
|
2020 Connected Care Select (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2241 -018 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,764
2020 Formulary |
|
|
|
|
2021 Connected Care Select (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 3,560 2021 Formulary |
|
2020 Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H3237 -001 -0 | 0% | 0% | 0% | | 3,451
2020 Formulary |
-- |
-- |
-- |
|
2021 Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 3,473 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0562 -125 -0 | | | | | |
|
|
|
|
2021 Health Net Gold Select (HMO)
| $0.00 |
$850 |
$0 | Yes, some additional gap coverage. | $0.00 | $1.00 | $42.00 | $42.00 | 3,370 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0562 -125 -0 | | | | | |
|
|
|
|
2021 Health Net Gold Select (HMO)
| $0.00 |
$850 |
$0 | Yes, some additional gap coverage. | $0.00 | $1.00 | $42.00 | $42.00 | 3,370 2021 Formulary |
|
2020 Health Net Seniority Plus Green (HMO)
| $0.00 |
$3,400 |
No Rx Coverage |
H0562 -044 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Health Net Green (HMO)
| $0.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0562 -044 -0 | | | | | |
|
|
|
|
2021 Health Net Green (HMO)
| $0.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 Health Net Jade (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0562 -092 -0 | $0.00 | $10.00 | $37.00 | $37.00 | 3,959
2020 Formulary |
|
|
|
|
2021 Health Net Jade (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $42.00 | $42.00 | 3,370 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0562 -092 -0 | | | | | |
|
|
|
|
2021 Health Net Jade (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $42.00 | $42.00 | 3,370 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Alignment Health Plan Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H3815 -010 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 3,280
2020 Formulary |
|
|
|
|
2021 Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 3,417 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H3815 -010 -0 | | | | | |
|
|
|
|
2021 Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 3,417 2021 Formulary |
|
2020 Humana Gold Plus H5619-021 (HMO)
| $0.00 |
$990 |
$0 | Yes, some additional gap coverage. |
H5619 -021 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus H5619-021 (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,382 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H5619 -021 -0 | | | | | |
|
|
|
|
2021 Humana Gold Plus H5619-021 (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,382 2021 Formulary |
|
2020 Humana Honor (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5619 -120 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Humana Honor (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2020 --
|
H5619 -120 -0 | | | | | |
|
|
|
|
2021 Humana Honor (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H5496 -012 -0 | | | | | |
new |
new |
|
|
2021 Imperial Dynamic Plan (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | 3,359 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5496 -012 -0 | | | | | |
new |
new |
|
|
2021 Imperial Dynamic Plan (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | 3,359 2021 Formulary |
|
2020 Imperial Senior Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5496 -005 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,374
2020 Formulary |
new |
new |
|
|
2021 Imperial Senior Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,404 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H5496 -005 -0 | | | | | |
new |
new |
|
|
2021 Imperial Senior Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,404 2021 Formulary |
|
2020 Imperial Traditional (HMO) (HMO)
| $0.00 |
$4,000 |
$0 | Yes, some additional gap coverage. |
H5496 -007 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,305
2020 Formulary |
new |
new |
|
|
2021 Imperial Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,359 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5496 -007 -0 | | | | | |
new |
new |
|
|
2021 Imperial Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,359 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Inter Valley Health Plan Service To Seniors (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. |
H0545 -001 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 2,736
2020 Formulary |
|
|
|
|
2021 Inter Valley Health Plan Service To Seniors (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 2,790 2021 Formulary |
|
2020 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
| $0.00 |
$4,000 |
$0 | Yes, some additional gap coverage. |
H0524 -003 -0 | $3.00 | $15.00 | $47.00 | $47.00 | 4,833
2020 Formulary |
|
|
|
|
2021 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $3.00 | $10.00 | $47.00 | $47.00 | 4,700 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0524 -003 -0 | | | | | |
|
|
|
|
2021 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $3.00 | $10.00 | $47.00 | $47.00 | 4,700 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8258 -001 -0 | 0% | 0% | 0% | 0% | 3,570
2020 Formulary |
-- |
-- |
-- |
|
2021 L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 3,534 2021 Formulary |
|
2020 Molina Dual Options (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8677 -002 -0 | 0% | 0% | 0% | | 3,184
2020 Formulary |
-- |
-- |
-- |
|
2021 Molina Dual Options (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 3,242 2021 Formulary |
|
2020 Alignment Health Plan My Choice (HMO)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. |
H3815 -001 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 3,280
2020 Formulary |
|
|
|
|
2021 My Choice (HMO)
| $0.00 |
$2,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 3,417 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H3815 -001 -0 | | | | | |
|
|
|
|
2021 My Choice (HMO)
| $0.00 |
$2,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 3,417 2021 Formulary |
|
2020 PHP (HMO C-SNP)
| $0.00 |
n/a |
$435 | Yes, some additional gap coverage. |
H5852 -001 -0 | 25% | 25% | 25% | 25% | 3,181
2020 Formulary |
-- |
-- |
|
|
2021 PHP (HMO C-SNP)
| $0.00 |
n/a |
$445 | Yes, some additional gap coverage. | 15% | 15% | 25% | 25% | 3,207 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5852 -001 -0 | | | | | |
-- |
-- |
|
|
2021 PHP (HMO C-SNP)
| $0.00 |
n/a |
$445 | Yes, some additional gap coverage. | 15% | 15% | 25% | 25% | 3,207 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Alignment Health Plan Platinum (HMO)
| $0.00 |
$1,499 |
$0 | Yes, some additional gap coverage. |
H3815 -008 -0 | $0.00 | $3.00 | $30.00 | $30.00 | 3,280
2020 Formulary |
|
|
|
|
2021 Platinum (HMO)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | 3,417 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H3815 -008 -0 | | | | | |
|
|
|
|
2021 Platinum (HMO)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | 3,417 2021 Formulary |
|
2020 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5425 -034 -0 | $0.00 | $2.00 | $30.00 | $30.00 | 3,337
2020 Formulary |
|
|
|
|
2021 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $2.00 | $30.00 | $30.00 | 3,383 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H5425 -034 -0 | | | | | |
|
|
|
|
2021 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $2.00 | $30.00 | $30.00 | 3,383 2021 Formulary |
|
2020 SCAN Classic (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. |
H5425 -006 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,337
2020 Formulary |
|
|
|
|
2021 SCAN Classic (HMO)
| $0.00 |
$799 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $37.00 | $37.00 | 3,383 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5425 -006 -0 | | | | | |
|
|
|
|
2021 SCAN Classic (HMO)
| $0.00 |
$799 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $37.00 | $37.00 | 3,383 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 SCAN Healthy at Home (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9104 -006 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,337
2020 Formulary |
-- |
-- |
-- |
|
2021 SCAN Healthy at Home (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,383 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H9104 -006 -0 | | | | | |
-- |
-- |
-- |
|
2021 SCAN Healthy at Home (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,383 2021 Formulary |
|
2020 Alignment Health Plan smartHMO (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H3815 -013 -0 | $0.00 | $10.00 | $30.00 | $30.00 | 3,280
2020 Formulary |
|
|
|
|
2021 smartHMO (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $30.00 | $30.00 | 3,417 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H3815 -013 -0 | | | | | |
|
|
|
|
2021 smartHMO (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $30.00 | $30.00 | 3,417 2021 Formulary |
|
2020 WellCare Best (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H5087 -005 -0 | $0.00 | $0.00 | $25.00 | $25.00 | 3,274
2020 Formulary |
|
-- |
|
|
2021 WellCare Best (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | 3,348 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5087 -005 -0 | | | | | |
|
-- |
|
|
2021 WellCare Best (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | 3,348 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 WellCare Dividend (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5087 -025 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
-- |
|
|
2021 WellCare Dividend (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5087 -025 -0 | | | | | |
|
-- |
|
|
2021 WellCare Dividend (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
2020 WellCare Freedom (HMO D-SNP)
| $1.10 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5087 -001 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
-- |
|
|
2021 WellCare Freedom (HMO D-SNP)
| $4.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H5087 -001 -0 | | | | | |
|
-- |
|
|
2021 WellCare Freedom (HMO D-SNP)
| $4.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
2020 WellCare Plus (HMO)
| $0.00 |
$2,500 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5087 -017 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
-- |
|
|
2021 WellCare Plus (HMO)
| $6.70 |
$2,500 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5087 -017 -0 | | | | | |
|
-- |
|
|
2021 WellCare Plus (HMO)
| $6.70 |
$2,500 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Anthem MediBlue Coordination Plus (HMO)
| $25.30 |
$6,700 |
$435 | Yes, some additional gap coverage. |
H0544 -072 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,768
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Coordination Plus (HMO)
| $12.20 |
$7,550 |
$445 | Yes, some additional gap coverage. | $0.00 | $15.00 | $47.00 | $47.00 | 3,621 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0544 -072 -0 | | | | | |
|
|
|
|
2021 Anthem MediBlue Coordination Plus (HMO)
| $12.20 |
$7,550 |
$445 | Yes, some additional gap coverage. | $0.00 | $15.00 | $47.00 | $47.00 | 3,621 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0562 -123 -0 | | | | | |
|
|
|
|
2021 Health Net Healthy Heart (HMO)
| $17.00 |
$2,400 |
$0 | Yes, some additional gap coverage. | $1.00 | $8.00 | $42.00 | $42.00 | 3,370 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0562 -123 -0 | | | | | |
|
|
|
|
2021 Health Net Healthy Heart (HMO)
| $17.00 |
$2,400 |
$0 | Yes, some additional gap coverage. | $1.00 | $8.00 | $42.00 | $42.00 | 3,370 2021 Formulary |
|
2020 AARP Medicare Advantage SecureHorizons Premier (HMO)
| $18.70 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H0543 -164 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 AARP Medicare Advantage SecureHorizons Premier (HMO)
| $19.10 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0543 -164 -0 | | | | | |
|
|
|
|
2021 AARP Medicare Advantage SecureHorizons Premier (HMO)
| $19.10 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Alignment Health Plan CalPlus (HMO)
| $27.30 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3815 -009 -0 | $0.00 | $14.00 | 25% | 25% | 3,280
2020 Formulary |
|
|
|
|
2021 CalPlus (HMO)
| $20.10 |
$4,900 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $14.00 | 23% | 23% | 3,417 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H3815 -009 -0 | | | | | |
|
|
|
|
2021 CalPlus (HMO)
| $20.10 |
$4,900 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $14.00 | 23% | 23% | 3,417 2021 Formulary |
|
2020 Humana Value Plus H5619-037 (HMO)
| $16.80 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5619 -037 -0 | $0.00 | $19.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Value Plus H5619-037 (HMO)
| $20.40 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $19.00 | $47.00 | $47.00 | 3,382 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H5619 -037 -0 | | | | | |
|
|
|
|
2021 Humana Value Plus H5619-037 (HMO)
| $20.40 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $19.00 | $47.00 | $47.00 | 3,382 2021 Formulary |
|
2020 UnitedHealthcare Medicare Advantage Assure (HMO)
| $14.90 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0543 -153 -0 | 25% | 25% | 25% | 25% | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Assure (HMO)
| $22.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0543 -153 -0 | | | | | |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Assure (HMO)
| $22.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Anthem MediBlue Connect (HMO D-SNP)
| $0.00 |
n/a |
$435 | Yes, some additional gap coverage. |
H0544 -003 -0 | $0.00 | $0.00 | 25% | 25% | 2,988
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Connect (HMO D-SNP)
| $23.30 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $0.00 | 25% | 25% | 3,057 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0544 -003 -0 | | | | | |
|
|
|
|
2021 Anthem MediBlue Connect (HMO D-SNP)
| $23.30 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $0.00 | 25% | 25% | 3,057 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0544 -122 -1 | | | | | |
|
|
|
|
2021 Anthem MediBlue Connect Plus (HMO)
| $23.50 |
$7,550 |
$445 | Yes, some additional gap coverage. | 25% | 25% | 25% | 25% | 3,057 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0544 -122 -1 | | | | | |
|
|
|
|
2021 Anthem MediBlue Connect Plus (HMO)
| $23.50 |
$7,550 |
$445 | Yes, some additional gap coverage. | 25% | 25% | 25% | 25% | 3,057 2021 Formulary |
|
2020 SCAN Prime (HMO)
| $25.00 |
$800 |
$0 | Yes, some additional gap coverage. |
H5425 -065 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,337
2020 Formulary |
|
|
|
|
2021 SCAN Prime (HMO)
| $25.00 |
$699 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $37.00 | $37.00 | 3,383 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5425 -065 -0 | | | | | |
|
|
|
|
2021 SCAN Prime (HMO)
| $25.00 |
$699 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $37.00 | $37.00 | 3,383 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Health Net Seniority Plus Sapphire Premier (HMO)
| $32.00 |
$6,700 |
$370 | No additional gap coverage, only the Donut Hole Discount |
H3561 -002 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,959
2020 Formulary |
|
|
|
|
2021 Health Net Sapphire Premier (HMO)
| $25.40 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,352 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H3561 -002 -0 | | | | | |
|
|
|
|
2021 Health Net Sapphire Premier (HMO)
| $25.40 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,352 2021 Formulary |
|
2020 Health Net Seniority Plus Amber II (HMO D-SNP)
| $32.00 |
n/a |
$350 | No additional gap coverage, only the Donut Hole Discount |
H0562 -121 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,959
2020 Formulary |
|
|
|
|
2021 Health Net Amber II (HMO D-SNP)
| $26.60 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,352 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0562 -121 -0 | | | | | |
|
|
|
|
2021 Health Net Amber II (HMO D-SNP)
| $26.60 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,352 2021 Formulary |
|
2020 Health Net Seniority Plus Sapphire Premier II (HMO)
| $32.00 |
$6,700 |
$410 | No additional gap coverage, only the Donut Hole Discount |
H3561 -005 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,959
2020 Formulary |
|
|
|
|
2021 Health Net Sapphire Premier II (HMO)
| $26.70 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,352 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H3561 -005 -0 | | | | | |
|
|
|
|
2021 Health Net Sapphire Premier II (HMO)
| $26.70 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,352 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Health Net Seniority Plus Amber I (HMO D-SNP)
| $32.00 |
n/a |
$350 | No additional gap coverage, only the Donut Hole Discount |
H0562 -055 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,959
2020 Formulary |
|
|
|
|
2021 Health Net Amber I (HMO D-SNP)
| $27.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,352 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0562 -055 -0 | | | | | |
|
|
|
|
2021 Health Net Amber I (HMO D-SNP)
| $27.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,352 2021 Formulary |
|
2020 Health Net Seniority Plus Sapphire (HMO)
| $0.00 |
$4,500 |
$370 | No additional gap coverage, only the Donut Hole Discount |
H0562 -122 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,959
2020 Formulary |
|
|
|
|
2021 Health Net Sapphire (HMO)
| $28.50 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,370 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0562 -122 -0 | | | | | |
|
|
|
|
2021 Health Net Sapphire (HMO)
| $28.50 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,370 2021 Formulary |
|
2020 Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)
| $31.10 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0524 -029 -0 | 15% | 15% | 15% | 15% | 4,833
2020 Formulary |
|
|
|
|
2021 Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)
| $30.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 4,700 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0524 -029 -0 | | | | | |
|
|
|
|
2021 Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)
| $30.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 4,700 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 Anthem MediBlue Extra (HMO)
| $14.40 |
$900 |
$435 | Yes, some additional gap coverage. |
H0544 -081 -0 | $0.00 | $2.00 | $47.00 | $47.00 | 3,768
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Extra (HMO)
| $31.50 |
$900 |
$445 | Yes, some additional gap coverage. | $0.00 | $2.00 | $47.00 | $47.00 | 3,621 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0544 -081 -0 | | | | | |
|
|
|
|
2021 Anthem MediBlue Extra (HMO)
| $31.50 |
$900 |
$445 | Yes, some additional gap coverage. | $0.00 | $2.00 | $47.00 | $47.00 | 3,621 2021 Formulary |
|
2020 Blue Shield Promise Coordinated Choice Plan (HMO)
| $32.00 |
$6,700 |
$435 | Yes, some additional gap coverage. |
H5928 -037 -0 | $0.00 | 25% | 25% | 25% | 3,112
2020 Formulary |
|
|
|
|
2021 Blue Shield Coordinated Choice Plan (HMO)
| $31.50 |
$6,700 |
$445 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | 3,202 2021 Formulary |
|